Nursing Fundamentals Quiz 2 CNI Airway management – Flashcards

mobilizing secretions suctioning the airway managing artificial airways (endotracheal tubes, tracheostomy tubes) to promote adequate gas exchange and lung expansion

includes *Resp assessment, vitals, pulse ox and O2. *Oxygen helps maintain cellular oxygenation for clients with acute and chronic respiratory problems (hypoxemia, cystic fibrosis, asthma) * or are at risk for developing hypoxia (respiratory illness, circulatory impairment).

* A device with a sensor probe that attaches securely to the fingertip, toe, bridge of nose, earlobe, or forehead with a clip or band. * measures pulse saturation (SpO2) via a wave of infrared light that measures light absorption by oxygenated and deoxygenated hemoglobin in arterial blood. * SpO2 reliably reflects the percent of saturation of hemoglobin (SaO2) when the SaO2 is greater than 70%. * Oxygen is a tasteless and colorless gas that accounts for 21% of atmospheric air. * Oxygen flow rates vary to maintain an SpO2 of 95% to 100% using the lowest amount of oxygen to achieve the goal without risking complications.

* pulse saturation * SpO2 reliably reflects the percent of saturation of hemoglobin (SaO2) when the SaO2 is greater than 70%.

is the percentage of oxygen the client receives.

* Noninvasive measurement of the oxygen saturation of the blood for monitoring respiratory status when assessment findings include any of the following. ●● Increased work of breathing ●● Wheezing ●● Coughing ●● Cyanosis ●● Changes in respiratory rate or rhythm ●● Adventitious breath sounds ●● Restlessness, irritability, confusion

* Confirm probe placement. * Confirm that the oxygen delivery system is functioning *client is receiving the prescribed oxygen levels. * Place the client in semi‑Fowler's or Fowler's position promote chest expansion and to maximize ventilation. * Encourage deep breathing. * Remain with the client and provide emotional support to decrease anxiety.

* The expected reference range is 95% to 100%. * Acceptable levels range from 91% to 100%. * Some illness states can allow for 85% to 89%. * Readings less than 90% reflect hypoxemia. * Values can be slightly lower for older adult clients and clients who have dark skin.

*hypothermia, *poor peripheral blood flow, *too much light (sun, infrared lamps), *low hemoglobin levels, *jaundice, *movement, *edema, *and nail polish

* Tachypnea * Tachycardia *Restlessness, anxiety, confusion *Pale skin, mucous membranes * Elevated blood pressure *Use of accessory muscles, nasal flaring, tracheal tugging, * adventitious lung sounds

* Stupor * Cyanotic skin, mucous membranes * Bradypnea * Bradycardia * Hypotension * Cardiac dysrhythmias

* Monitor respiratory rate and pattern, level of consciousness, SpO2, and arterial blood gases. * Provide oxygen therapy at the lowest liter flow that will correct hypoxemia. * Oxygen is a therapeutic gas that treats hypoxemia (low levels of arterial oxygen). Administering and adjusting it requires a prescription. * Make sure the mask creates a secure seal over the nose and mouth. * Assess/monitor hypoxemia and hypercarbia (elevated levels of CO2): restlessness, hypertension, and headache. Auscultate the lungs for breath sounds and adventitious sounds, such as crackles and wheezes. * Assess/monitor oxygenation status with pulse oximetry and arterial blood gases (ABGs). * Promote oral hygiene. * Encourage turning, coughing, deep breathing, and the use of incentive spirometry and suctioning. * Promote rest and decrease environmental stimuli. * Provide emotional support. * Assess nutritional status. Provide supplements. * * Assess skin integrity. Provide moisture and pressure‑relief devices. * Assess and document the response to oxygen therapy. * Titrate oxygen to maintain the recommended oxygen saturation. * Discontinue supplemental oxygen gradually. Monitor for respiratory depression (decreased respiratory rate and level of consciousness). * Low‑flow oxygen delivery systems deliver varying amounts of oxygen based on the delivery method and the client's breathing pattern.

low levels of arterial oxygen.

elevated levels of CO2

Tubing with two small prongs for insertion into the nares FRACTION OF INSPIRED OXYGEN: Delivers an FiO2 of 24% to 44% at a flow rate of 1 to 6 L/min * ADVANTAGES: Cannula is a safe, simple, and easy‑to‑apply method. Cannula is comfortable and well‑tolerated. The client is able to eat, talk, and ambulate. * DISADVANTAGES: The FiO2 varies with the flow rate, and rate and depth of the client's breathing. *Extended use can lead to skin breakdown and dry mucous membranes. * Tubing is easily dislodged. Assess the patency of the nares. Ensure that the prongs fit in the nares properly. * Use water‑soluble gel to prevent dry nares. * Provide humidification for flow rates of 4 L/min and greater.

Covers the client's nose and mouth * FRACTION OF INSPIRED OXYGEN: It delivers an FiO2 of 40% to 60% at flow rates of 5 to 8 L/min. * The minimum flow rate is 5 L/min to ensure flushing of CO2 from the mask. * ADVANTAGES: easy to apply, comfortable, simple delivery method, provides humidified oxygen. * DISADVANTAGES: Flow rates less than 5 L/min can result in rebreathing of CO2. * Clients who have anxiety or claustrophobia do not tolerate it well. * Eating, drinking, and talking are impaired. * Moisture and pressure can collect under the mask and cause skin breakdown. NURSING ACTION: Assess proper fit to ensure a secure seal over the nose and mouth. Make sure the client wears a nasal cannula during meals. Use with caution for clients who have a high risk of aspiration or airway obstruction. Monitor for skin breakdown.

Covers the client's nose and mouth Delivers an FiO2 of 40% to 70% at flow rates of 6 to 10 L/min. * ADVANTAGES: The mask has a reservoir bag attached with no valve, which allows the client to rebreathe up to ⅓ of exhaled air together with room air. * DISADVANTAGES: Complete deflation of the reservoir bag during inspiration causes CO2 buildup. * The FiO2 varies with the client's breathing pattern. * Clients who have anxiety or claustrophobia do not tolerate it well. * Eating, drinking, and talking are impaired. NURSING ACTIONS: Keep the reservoir bag from deflating by adjusting the oxygen flow rate to keep the reservoir bag ⅓ to ½ full on inspiration. * Assess proper fit to ensure a secure seal over nose and mouth. * Assess for skin breakdown beneath the edges of the mask and bridge of the nose. * Make sure the client uses a nasal cannula during meals. Use with caution for clients who have a high risk of aspiration or airway obstruction.

Covers the client's nose and mouth * Delivers an FiO2 of 60% to 100% at flow rates of 10 to 15 L/min to keep the reservoir bag ⅔ full during inspiration and expiration. * ADVANTAGES: It delivers the highest O2 concentration possible (except for intubation). A one‑way valve situated between the mask and reservoir allows the client to inhale maximum O2 from the reservoir bag. * The two exhalation ports have flaps covering them that prevent room air from entering the mask. * DISADVANTAGES: The valve and flap on the mask must be intact and functional during each breath. * It is poorly tolerated by clients who have anxiety or claustrophobia. Eating, drinking, and talking are impaired. Use with caution for clients who have a high risk of aspiration or airway obstruction. * Nursing Actions: Perform an hourly assessment of the valve and flap. Assess proper fit to ensure a secure seal over the nose and mouth. Assess for skin breakdown beneath the edges of the mask and bridge of nose. Make sure the client uses a nasal cannula during meals.

Covers the client's nose and mouth * FRACTION OF INSPIRED OXYGEN: Delivers an FiO2 of 24% to 60% at flow rates of 4 to 12 L/min via different size adapters, which allows specific amounts of air to mix with oxygen. ADVANTAGES: It delivers the most precise oxygen concentration. * Humidification is not required. * Best for clients who have chronic lung disease. * DISADVANTAGES: expensive. Eating, drinking, and talking are impaired. * NURSING ACTIONS: Assess frequently to ensure an accurate flow rate. Assess proper fit to ensure a secure seal over the nose and mouth. Assess for skin breakdown beneath the edges of the mask particularly on the nares. Make sure the tubing is free of kinks. Ensure that the client wears a nasal cannula during meals.

Face tent: fits loosely around the face and neck * Tracheostomy collar: a small mask that covers the surgically created opening of the trachea * FRACTION OF INSPIRED OXYGEN: Delivers an FiO2 of 24% to 100% at flow rates of at least 10 L/min. * Provides high humidification with oxygen delivery. * ADVANTAGES: Use with clients who do not tolerate masks well. * Useful for clients who have facial trauma, burns, and thick secretions. DISADVANTAGES: High humidification requires frequent monitoring. NURSING ACTIONS ●● Empty condensation from the tubing often. ●● Ensure adequate water in the humidification canister. ●● Ensure that the aerosol mist leaves from the vents during inspiration and expiration ●● Make sure the tubing does not pull on the tracheostomy.

Oxygen toxicity can result from high concentrations of oxygen (typically greater than 50%), * long durations of oxygen therapy (typically more than 24 to 48 hr), and the severity of lung disease. MANIFESTATIONS: Nonproductive cough, substernal pain, nasal stuffiness, nausea, vomiting, fatigue, headache, sore throat, and hypoventilation NURSING ACTIONS Use the lowest level of oxygen necessary to maintain an adequate SpO2. Monitor ABGs and notify the provider if SpO2 levels are outside the expected reference range. Decrease the FiO2 as the client's SpO2 improves.

Clients who have conditions that cause alveolar hypoventilation can be sensitive to the administration of oxygen. NURSING ACTIONS ●● Monitor respiratory rate and pattern, level of consciousness, and SpO2. ●● Provide oxygen therapy at the lowest liter flow rate that manages hypoxemia. ●● If the client tolerates it, use a Venturi mask to deliver precise oxygen levels. ●● Notify the provider of impending respiratory depression such as a decreased respiratory rate and a decreased level of consciousness.

●● Post "No Smoking" or "Oxygen in Use" signs to alert others of the fire hazard. ●● Know where to find the closest fire extinguisher. ●● Educate about the fire hazard of smoking with oxygen use. ●● Have clients wear a cotton gown because synthetic or wool fabrics can generate static electricity. ●● Ensure that all electric devices (razors, hearing aids, radios) are working well. ●● Make sure all electric machinery (monitors, suction machines) is grounded. ●● Do not use volatile, flammable materials (alcohol, acetone) near clients receiving oxygen.

Mucosal secretion buildup or aspiration of emesis can obstruct a client's airway. Adequate hydration and coughing help the client maintain airway patency. Nursing interventions that mobilize secretions and maintain airway patency include: * assistance with coughing, hydration, positioning, humidification, nebulizer therapy, chest physiotherapy, and suctioning. *These interventions promote adequate gas exchange and lung expansion.

infants, clients who have neuromuscular disorders, clients who ar quadriplegic, clients who have cystic fibrosis

* hypoxemia (restlessness, irritability, tachypnea, tachycardia, cyanosis, decreased level of consciousness, decreased SpO2 levels), * adventitious breath sounds, * visible secretions, * absence of spontaneous cough

Humidification of oxygen moistens the airways, which loosens and mobilizes pulmonary secretions. ●● Nebulization breaks up medications (bronchodilators, mucolytic agents) into minute particles that disperse throughout the respiratory tract and improves clearance of pulmonary secretions. ●● Chest physiotherapy involves the use of chest percussion, vibration, and postural drainage to help mobilize secretions. **Chest percussion and vibration facilitate movement of secretions into the central airways. **For postural drainage, one or more positions allow gravity to assist with the removal of secretions from specific areas of the lung. ●● Early‑morning postural drainage mobilizes secretions that have accumulated through the night.

Collect sputum specimens by suctioning during coughing. ●● Whenever possible, encourage coughing. Coughing is more effective than artificial suctioning at moving secretions into the upper trachea and laryngopharynx. ●● Suction orally, nasally, or endotracheally, not routinely but only when clients need it. ●● Maintain surgical asepsis when performing any form of tracheal suctioning to avoid bacterial contamination of the airway.

For cytology to identify aberrant cells or cancer For culture and sensitivity to grow and identify micro‑organisms and the antibiotics effective against them Presence of micro‑organisms indicating infection To identify acid‑fast bacillus (AFB) to diagnose tuberculosis (requires three consecutive morning samples)

Obtain specimens early in the morning. Wait 1 to 2 hr after the client eats to obtain a specimen to decrease the likelihood of emesis or aspiration. ●● Perform chest physiotherapy to help mobilize secretions. ●● Use a sterile specimen container, a label, a laboratory requisition slip, a biohazard bag for delivery of the specimen to the laboratory, clean gloves, and a mask and goggles if necessary. ●● Use a container with a preservative to obtain a specimen for cytology. ●● Use a sterile container for routine cultures and AFB testing. ●● If a client cannot cough effectively and expectorate sputum into the container, collect the specimen by endotracheal suctioning. ●● Older adult clients have a weak cough reflex and decreased muscle strength, making it difficult for them to expectorate. They can require suctioning for sputum specimen collection.

acid‑fast bacillus (AFB)

Techniques that loosen respiratory secretions and move them into the central airways where coughing or suctioning can remove them ●● For clients who have thick secretions and are unable to clear their airways Percussion: the use of cupped hands to clap rhythmically on the chest to break up secretions Vibration: the use of a shaking movement during exhalation to help remove secretions Postural drainage: the use of various positions to allow secretions to drain by gravity

clients who are pregnant; have a rib, chest, head, or neck injury; have increased intracranial pressure; have had recent abdominal surgery; have a pulmonary embolism; have bleeding disorders or osteoporosis

Schedule treatments 1 hr before or 2 hr after meals, and at bedtime to decrease the likelihood of vomiting or aspirating. Administer a bronchodilator medication or nebulizer treatment 30 min to 1 hr prior to postural drainage. Offer the client an emesis basin and facial tissues. Apply manual percussion to the chest wall using cupped hands or a specific device. Have the client cough after each set of vibrations. Have the client remain in each position for 10 to 15 min to allow time for percussion, vibration, and postural drainage. Discontinue the procedure if the client reports faintness or dizziness. Note that older adult clients have decreased respiratory muscle strength and chest wall compliance, which puts them at risk for aspiration. They require more frequent position changes and other interventions to promote mobility of secretions

Suction orally, nasally, or endotracheally when clients have early signs of hypoxemia, such as restlessness, confusion, tachypnea, tachycardia, decreased SpO2 levels, adventitious breath sounds, audible or visible secretions, cyanosis, and absence of spontaneous cough. Don the required PPE. Assist the client to high‑Fowler's or Fowler's position for suctioning if possible. Encourage the client to breathe deeply and cough in an attempt to clear the secretions without artificial suction. Obtain baseline breath sounds and vital signs, including SaO2 by pulse oximeter. monitor SaO2 continually during the procedure.

use a Yankauer or tonsil‑tipped rigid suction catheter and move the catheter around the mouth, gum line, and pharynx.

use a flexible catheter and lubricate the distal 6 to 8 cm (2 to 3 in) with water‑soluble lubricant.

use a suction catheter. The catheter should not exceed one half of the internal diameter of the endotracheal tube to prevent hypoxia. The nurse should use no larger than a 16 French suction catheter when suctioning an 8 mm endotracheal tube or tracheostomy tube. Hyperoxygenate the client using a bag‑valve‑mask (BVM) or specialized ventilator function with an FiO2 of 100%. ●● Use medical asepsis for suctioning the mouth. ●● Use surgical asepsis for all other types of suctioning. ●● Use suction pressure no higher than 120 to 150 mm Hg. ●● Limit each suction attempt to no longer than 10 to 15 seconds to avoid hypoxemia and the vagal response. Repeat suctioning if needed. Limit total suctioning time to 5 minutes.

Insert the catheter into the naris during inhalation. Do not apply suction while inserting the catheter. Follow the natural course of the naris and slightly slant the catheter downward while advancing it. Advance the catheter the approximate distance from the tip of the nose to the base of the earlobe. Apply suction intermittently by covering and releasing the suction port with the thumb for 10 to 15 seconds. Apply suction only while withdrawing the catheter and rotating it with the thumb and forefinger. Do not perform more than two passes with the catheter. Allow at least 1 min between passes for ventilation and oxygenation.

Remove the bag or ventilator from the tracheostomy or endotracheal tube and insert the catheter into the lumen of the airway. Advance the catheter until resistance is met. The catheter should reach the level of the carina (location of bifurcation into the mainstem bronchi). Pull the catheter back 1 cm (0.4 in) prior to applying suction to prevent mucosal damage. Apply suction intermittently by covering and releasing the suction port with the thumb for 10 to 15 seconds. Apply suction only while withdrawing the catheter and rotating it with the thumb and forefinger. Reattach the BVM or ventilator and administer 100% oxygen. Rinse catheter and suction tubing with sterile saline until clear. Do not reuse the suction catheter for subsequent suctioning sessions.

A tracheostomy is the stoma/opening that results from a tracheotomy to provide and secure a patent airway. Artificial airways can be placed orotracheally, nasotracheally, or through a tracheostomy to assist with respiration. Tracheostomy tubes vary in their composition (plastic, steel, silicone), number of parts, size (long vs. short), and shape (50° to 90° angles). There is no standard tracheostomy sizing system. However, the diameter of the tracheostomy tube must be smaller than the trachea.

* a sterile surgical incision into the trachea through the skin and muscles for the purpose of establishing an airway. A tracheotomy can be an emergency or a scheduled surgical procedure; it can be temporary or permanent.

include acute or chronic upper airway obstruction, edema, anaphylaxis, burns, trauma, head/neck surgery, copious secretions, obstructive sleep apnea refractory to conventional therapy, the need for long‑term mechanical ventilation or reconstruction after laryngeal trauma or laryngeal cancer surgery.

Single‑lumen (cannula): Long, single‑cannula tube For clients who have long or thick necks. Do not use with clients who have excessive secretions. Double‑lumen (cannula): An outer cannula fits into the stoma and keeps the airway open. An inner cannula fits snugly into the outer cannula and locks into place. This device allows removing, cleaning, reusing, discarding, and replacing the inner cannula with a disposable inner cannula. It is useful for clients who have excessive secretions. An obturator is a thin, solid tube the provider places inside the tracheostomy and uses as a guide for inserting the outer cannula, and removes immediately after outer cannula insertion.

Cuffed tube has a balloon that inflates around the outside of the distal segment of the tube to protect the lower airway by producing a seal between the upper and lower airway. A cuffed tube permits mechanical ventilation, prevents aspiration of oropharyngeal secretions. Cuffs do not hold the tube in place. Cuff pressures must be monitored to prevent tracheal tissue necrosis. The client is unable to speak. Children do not require a cuffed tube

It has one large or multiple openings (fenestrations) in the posterior wall of the outer cannula with a balloon around the outside of the distal segment of the tube. It also has an inner cannula. Removing the inner cannula allows the fenestrations to permit air to flow through the openings. This device allows for mechanical ventilation. This device allows the client to speak.

It has no balloon and is for clients who have long‑term airway management needs. The client must be at low risk for aspiration. Cuffless tubes are not for clients on mechanical ventilation. This device allows the client to speak. Fenestrated tube without cuffs: Have one larger or multiple openings (fenestrations) in the posterior wall of the outer cannula with no balloon. It also has an inner cannula. The holes in the tube help wean the client from the tracheostomy. Removing the inner cannula allows the fenestrations to permit air to flow through the openings. This device allows the client to speak.

Keep the following at the bedside: two extra tracheostomy tubes (one the client's size and one size smaller, in case of accidental decannulation), the obturator for the existing tube an oxygen source, suction catheters and a suction source a BVM. Provide methods to communicate with staff (paper and pen, dry‑erase board). Provide an emergency call system and a call light. Provide adequate humidification and hydration to thin secretions and reduce the risk of mucous plugs. Give oral care every 2 hr Provide tracheostomy care every 8 hr to reduce the risk of infection and skin breakdown.

Suction the tracheostomy tube, if necessary, using sterile suctioning supplies. Remove soiled dressings and excess secretions. Apply the oxygen source loosely if the client's SpO2 decreases during the procedure. Use cotton‑tipped applicators and gauze pads to clean exposed outer cannula surfaces. Use the facility‑approved solution. Clean in a circular motion from the stoma site outward. Use surgical asepsis to remove and clean the inner cannula (with the facility‑approved solution). Use a new inner cannula if it is disposable. Clean the stoma site and then the tracheostomy plate. Place a fresh split‑gauze tracheostomy dressing of nonraveling material under and around the tracheostomy holder and plate. Replace tracheostomy ties if they are wet or soiled. Secure the new ties before removing the soiled ones to prevent accidental decannulation. If a knot is needed, tie a square knot that is visible on the side of the neck. Check that one or two fingers fit between the tie and the neck.

Change nondisposable tracheostomy tubes every 6 to 8 weeks or per protocol. Reposition the client every 2 hr to prevent atelectasis and pneumonia. Minimize dust in the room. Do not shake bedding. If the client is permitted to eat, position him upright and tip his chin to his chest to enable swallowing. Assess for aspiration.

Accidental decannulation in the first 72 hr after surgery is an emergency because the tracheostomy tract has not matured, and replacement can be difficult. Ventilate the client with a BVM. Call for assistance. Always keep the tracheostomy obturator and two spare tracheostomy tubes at the bedside. If unable to replace the tracheostomy tube, administer oxygen through the stoma. If unable to administer oxygen through the stoma, occlude the stoma and administer oxygen through the nose and mouth. If accidental decannulation occurs after the first 72 hr Immediately hyperextend the neck and with the obturator inserted into the tracheostomy tube, quickly and gently replace the tube and remove the obturator. Secure the tube. Assess tube placement by auscultating for bilateral breath sounds.

Tracheal stenosis: Narrowing of the tracheal lumen due to scar formation resulting from irritation of the tracheal mucosa from the tracheal tube cuff. NURSING CONSIDERATIONS ●● Keep the cuff pressure between 14 and 20 mm Hg. ●● Check the cuff pressure at least once every 8 hr. ●● Keep the tube in the midline position and prevent pulling or traction on the tracheostomy tube. Tracheal wall necrosis: Tissue damage that results when the pressure of the inflated cuff impairs blood flow to the tracheal wall.

A. CORRECT: The nurse should monitor for restlessness, which is an early manifestation of hypoxemia, along with tachycardia, elevated blood pressure, use of accessory muscles, nasal flaring, tracheal tugging, and adventitious lung sounds. B. CORRECT: The nurse should monitor for tachypnea, which is an early manifestation of hypoxemia. C. Bradycardia is a late manifestation of hypoxemia, along with stupor, cyanotic skin and mucous membranes bradypnea, hypotension, and cardiac dysrhythmias. D. CORRECT: The nurse should monitor for confusion, which is an early manifestation of hypoxemia. E. CORRECT: The nurse should monitor for pallor, which is an early manifestation of hypoxemia

A. T he nurse might need to increase the client's oxygen flow, as hypoxemia can be the cause of his difficulty breathing. However, another action is the priority. B. CORRECT: The priority action the nurse should take whenusing the airway, breathing, circulation (ABC) approach to care delivery is to relieve dyspnea (difficulty breathing). Fowler' position facilitates maximal lung expansion and thus optimize breathing. With the client in this position, the nurse can betterassess and determine the cause of the client's dyspnea. C. T he nurse might need to suction the client or encourage expectoration of pulmonary secretions However, another action is the priority, D. T he nurse should check the client's oxygenation status. However, another action is the priority.

A. CORRECT: The nurse should apply suction pressure only while withdrawing the catheter to prevent damaging the tracheal tissue. B. T he nurse should suction the client only as needed, because suctioning is not without risk. It can cause mucosal damage, bleeding, and bronchospasm. C. T he nurse should use surgical asepsis when performing endotracheal suctioning to prevent contamination with microorganism that can cause an infection. D. CORRECT: The nurse should use a new suction catheter, unless an in‑line suctioning system is in place, to prevent contamination with microorganism that can cause an infection. E. CORRECT: To prevent hypoxemia, the nurse should limit total suctioning time to 5 minutes and allow at least 1 min between passes for ventilation and oxygenation.

A. CORRECT: The nurse should provide supplemental oxygen in response to any decline in oxygen saturation while performing tracheostomy care. B. CORRECT: The nurse should use a sterile disposable tracheostomy cleaning kit or sterile supplies and maintain surgical asepsis throughout this part of the procedure. C. CORRECT: The nurse should cleanse the surface around the stoma in a circular motion from the stoma site outward. Cleansing in this manner helps move mucus and contaminated material away from the stoma for easy removal. D. T he nurse should replace the tracheostomy ties if they are wet or soiled. There is a risk of tube dislodgement with replacing the ties, so he should not replace them routinely. E. T he nurse should use a commercially prepared tracheostomy dressing with a slit in it. Cutting gauze squares can loosen lint or gauze fibers the client could aspirate.

A. T he nurse should teach the client to apply a water‑based lubricant to protect the nares from drying during oxygen therapy. B. T he nurse should teach the client to leave the nasal cannula on while eating because it does not interfere with eating. C. CORRECT: The nurse should teach the client that a disadvantage of the nasal cannula is that it dislodges easily. The client should form the habit of checking its position periodically and readjusting it as necessary. D. CORRECT: The nurse should teach the client about oxygen toxicity, which is a complication of oxygen therapy, usually from high concentrations or long durations. Manifestations include a nonproductive cough, substernal pain, nasal stuffiness, nausea, vomiting, fatigue, headache, sore throat, and hypoventilation. The client should report any of these promptly. E. CORRECT: The nurse should teach the client that oxygen is combustible and thus increases the risk of fire injuries. No one in the house should smoke or use any device that might generate sparks in the area where the oxygen is in use.